Nasopharyngeal Carcinoma

ICD-O:8070/3

Keratinising nasopharyngeal carcinoma (squamous cell carcinoma, SCC) occurs typically after 40 years of age and shows obvious squamous differentiation with varying amounts of keratinisation. The stroma is desmoplas-tic and infiltrated by variable numbers of lymphocytes, plasma cells, neutrophils and eosinophils. Poorly differentiated SCC may only contain rare horn pearls or focal areas of easily recognisable cornification. Immu-nohistochemical analysis with antibody to involucrin is helpful in identifying areas of abortive keratinisation [98]. EBV is almost always positive in nasopharyngeal SCC in endemic areas for nasopharyngeal carcinoma, but only a small number of cases in low incidence areas are positive for EBV. SCC shows a greater propensity for localised advanced tumour growth, but a lower rate of lymph node metastases [141, 164]. Radical surgery is not performed since radiotherapy is extremely effective. Survival and prognosis of SCC depends on tumour stage and has been reported to be better than that for non-ke-ratinising nasopharyngeal carcinoma.

an insidiously growing tumour with a predisposition for perineural spread, local recurrence and distant metastasis. Regional lymph node metastases are rare. His-tologically, adenoid cystic carcinomas are classified in tubular, cribriform and solid subtypes. The tubular and cribriform subtypes are considered low-grade tumours; the solid sub-type is a high-grade tumour with a rapid, fatal course and a higher incidence of distant metastasis with a poor prognosis [114]. When compared with conventional nasopharyngeal carcinoma, adenoid cystic carcinoma has a higher incidence of cranial nerve involvement, but a lower incidence of cervical lymph node metastases.

Polymorphous low-grade adenocarcinoma of minor salivary glands (ICD-O:8525/3) (or terminal duct carcinoma, lobular carcinoma, low-grade papillary ad-enocarcinoma) is a low-grade neoplasm typically occurring in the oral cavity. It has been documented in the nasopharynx in rare cases [144, 198]. The polymorphous low-grade carcinoma has a wide diversity of histological patterns including solid areas, papillary growth, ductal differentiation, cystic spaces and an in-filtrative growth pattern with perineural invasion. The main bulk of the carcinoma is found in the submuco-sa and the surface epithelium is often intact. In the nasopharynx, surgery or radiotherapy is the treatment of choice. Polymorphous low-grade carcinomas of salivary gland origin have a potentially aggressive biological course with metastases to cervical lymph nodes. For a detailed description of salivary gland tumours see Chap. 5.

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